Imagine you have the misfortune to be diagnosed with cancer. Perhaps you have already faced this devastating illness, experiencing first-hand the distress, fear and uncertainty that comes with it. A small comfort for many is that, under NHS waiting time standards, cancer patients have the right to fast access to the best possible evidence-based treatment – a right which is fiercely defended by politicians, the media and the public.

But now imagine you are told that you won’t be given the treatment you need. Services are under-funded and under-staffed to the point where the full package of care isn’t available. You are told that you will only receive a shortened chemotherapy cycle; that you can only have chemotherapy when what you need is a combined course of chemotherapy and radiotherapy; or even that you won’t receive the full package because you are over the age of 35.

In short, you won’t get the treatment that will dramatically improve your chances of recovery – the treatment that you should be guaranteed under standards of care enshrined in the NHS constitution.

This would never be tolerated in the NHS, and rightly so. Yet this is the reality for thousands of people with severe mental health problems, who are experiencing their first episode of psychosis but are being denied the standards of care they have the right to expect.

When the Liberal Democrats were in government, one of the most important steps we took towards achieving ‘parity of esteem’ in the NHS was the introduction of the first ever access and waiting time standards in mental health care. This included a guarantee that from April 2016, at least 50% of people with psychosis would receive a high-quality, NICE-approved approved package of care within two weeks of referral.

Every day seems to bring new crushing evidence of the immense strain facing the NHS and social care. Missed key targets have become the norm rather than the exception; A&E is bearing the brunt of cuts to preventive and community services; and few were surprised when NHS trusts recently revealed a record deficit of £2.45 billion.

After hearing anecdotal accounts of ambulances queueing up outside A&E departments due to a lack of available beds in my own county of Norfolk, I decided to investigate the true scale of the problem across the whole country by submitting Freedom of Information requests to each Ambulance Trust in England.

What I discovered was far more shocking than I had feared. More than 10,000 patients were stuck in an ambulance for more than two hours waiting to be handed over to hospital staff last year – a staggering four-fold increase over just three years. The number of people having to endure waits of more than an hour before being admitted has almost trebled in the same period.

In total, almost 400,000 hours were wasted in the last year alone due to handover delays of more than 15 minutes, the national target for getting patients out of the ambulance and into the care of A&E staff. That’s equivalent to 16,554 days of patients waiting in limbo while ambulance crews and vehicles are unnecessarily tied up, unable to respond to new emergency calls.

You will have probably heard by now that the Assisted Dying Bill was defeated in Parliament this afternoon by a margin of about three to one.

The scale of victory for opponents of the Bill was almost exactly the same as when it was last debated in 1997. This is remarkable, given the degree of public support for reform – over 80% according to a poll earlier this year. I respect the deeply held convictions of those who oppose assisted dying but I can’t help but reflect on how out of step with public mood Parliament appears to be on this issue of such profound importance. And before anyone reacts – yes I understand we have a representative democracy and I know that it cuts both ways. I am deeply relieved that Parliament has always rejected hanging!

I used to oppose assisted dying. I shared the concerns of many people about the risk this could pose to vulnerable individuals under pressure from greedy relatives. However, in recent years my views have been challenged.

During my time as a Health Minister and my years as a Member of Parliament I have heard the testimonies of people with terminal conditions, often in great pain, who wanted the right to end their suffering with dignity and in a way of their choosing. Listening to these stories has forced me to confront the principles at stake.

Ultimately, the question surely is: should it be the individual or the state who decides? For me, as a Liberal, there can be no doubt. I know that I would want the right to decide for myself, so I cannot deny it to others.

As Care Minister, I was completely focused on improving end of life care, an area of medicine too often neglected in the past. I had to address really serious concerns about how the Liverpool Care Pathway had been applied in many hospitals as a one size fits all protocol.

What has emerged from the review I initiated is a new approach which focuses completely on the priorities and needs of the individual patient. There is a strong consensus now that, at the end of life, the patient’s wishes come first – on resuscitation, on where to die and so on. How odd then, that when it comes to the most profound question of all, we deny the person the right to decide.

The current legal situation is not just a messy compromise; it is cruel and wrong. We put families into the most invidious position. If they act out of compassion in helping a loved one to die, they still face having their home declared a ‘crime scene’ and then face an investigation which could go on for months, interfering horribly with the process of grieving. The DPP guidelines talk about ‘the suspect’. Surely we can’t put people through this.

Some people, of course, travel to another country to end their life, if they can afford it. But even that is, surely, grotesque – expecting a dying person to travel to an alien clinic in another country, when they could be at home with loved ones. For those who can’t afford to travel, they face the dreadful choice of soldiering on, perhaps in great pain and loss of dignity – or commit suicide. A Labour MP today wrote of how his own father ended his life in this way. Surely, again, this is intolerable.

Another concern people often raise is that giving people the right to die would somehow distract from, or conflict with, steps to ensure excellent palliative care. But good palliative care and assisted dying are in no way incompatible. It is up to Parliament to ensure that we invest enough in palliative care. In Oregon, where assisted dying has been lawful for many years, there is better access to specialist palliative care than in most other states.

John Stuart Mill wrote: “The only part of the conduct of anyone, for which he is amenable to society, is that which concerns others. In the part which merely concerns himself, his independence is, of right, absolute. Over himself, over his own body and mind, the individual is sovereign.”

I will keep campaigning for that sovereignty to be respected at the end of life, despite the defeat in Parliament today.

I believe a priority for the new Leader of the Liberal Democrats is to renew, restructure and simplify the way our Party works. Some parts of the Party work well – others do not. Good practice should be shared and problem areas tackled.

As Liberal Democrats, we rightly set high standards for ourselves on tolerance, equality, openness, accountability, and diversity. But our party often doesn’t live up to them.

During this campaign people have been telling me that there wasn’t enough accountability within the party. People had concerns about our central message and the way we fought the election – but it felt like there was no easy channel to get those messages through. And where mistakes were made, it wasn’t clear who ultimately was responsible.

Few party members really understand how our party works. There are so many committees with overlapping responsibility. The process for election to many offices within the party is arcane. If no-one knows how our party structures work, there cannot be effective accountability.

For many years, I opposed attempts to legalise assisted dying. I had concerns, shared by many, that the risk to the most vulnerable individuals outweighed the benefits. Equally, I respect those with deeply held religious concerns.

But my views have been challenged in recent years. As an MP and in my role in the last Parliament as a health minister, I have spoken to many terminally ill patients, and the families of those who suffered slow deaths in great pain.

So many of them were convinced, when someone is suffering intolerably, and when they are reaching the end of their life, they should be allowed to end their suffering with dignity, and with the support of those closest to them.

These testimonies have forced me to think again. Would I want the right to decide for myself, when faced with terminal illness, when I wished to die? And would I want it for loved ones? The answer is unequivocally, yes.

The campaign for the leadership of our party is now underway and I am excited by the prospect and humbled by the many messages of support and encouragement I have received.

However as a party we need to look at how we operate and what we look like to the outside world. One issue, in particular, now has an urgency to it which we can’t ignore. We have danced around gender imbalance at the highest levels for too long ….. and I am not prepared to wait a further five years before women are able to feature at the leadership level. Given that there were no women elected to the House of Commons and so no woman can stand for the leadership, I believe it is essential that the deputy leader is a woman.

Consequently, as leader I will immediately propose to the federal executive that we should move to elect a Deputy Leader who is not required to be a member of the House of Commons, but who will play a major role as one of the party’s leading voices and campaigners. She could be one of the former or future colleagues mentioned below; a peer, a member of a devolved chamber or the European Parliament; a leading councillor or seasoned campaigner.

1 in 4 of us will develop a mental health problem at some point in our lives – and 75% of these conditions develop by the age of 18. If people don’t get the support they need in childhood and adolescence it can have an impact on the rest of their lives.

And in yesterday’s budget, Liberal Democrats acted decisively to make sure the best possible support is available, with £1.25bn of new investment in young people’s mental health services, and a clear blue print for delivering the transformation needed.

If we want to build a fairer society, where everyone has the opportunity to realise their full potential in life, we must ensure that young people with mental health problems get the help and support they need.

There are some really good mental health services for young people around the country. But too often these services are fragmented and under-resourced, and young people are simply not getting help when they need it. A complete overhaul is long overdue.

Last year, I set up a Task Force to look at how we can link up mental health services with other advice services in the community, making it easier – and less daunting – for young people to seek help, and making sure they get the right support when they ask for it.

The task force brought together clinicians, counsellors, and mental health experts – but also, crucially, young people themselves with experience of mental health problems. The charity Young Minds helped us work with young people to understand the problems they have faced getting help, and their priorities for change.

Regular readers will be used to me banging my drum on these pages about the work that Lib Dems are doing in government on mental health.

Mental health has been disadvantaged within the NHS for far too long, and changes like legislating for equality for mental health, introducing the first access and waiting time standards, and – in particular – confronting the poor state of children’s mental health services in many places are all incredibly important.

But something just as important has been happening here on Lib Dem Voice today.

I wrote here about Time to Talk a year ago, saying that contributions from fellow members had reinforced for me, powerfully, why I am a Liberal Democrat. Tackling mental health stigma is fundamentally about freedom – freedom from poverty, ignorance, and conformity.

It may seem hard to imagine, but until 1992 the World Health Organisation classified homosexuality as a form of mental illness. Academic studies have shown an extraordinary prevalence, not too long ago, of therapists seeking to ‘convert’ gay people to become heterosexual – treating people’s sexuality as an illness rather than an inherent part of who they are.

In recent decades, society and the medical professions have fortunately come a long way. Most people now recognise that this as dangerous nonsense.

But there remain a few counsellors who still believe in the “treatment” of homosexuality to combat same-sex attractions. I said nearly a year ago now that, although there was no evidence to suggest that such practices were taking place in the NHS, I wanted to do all that I could to put an end to them once and for all.

As Liberal Democrats it is incredibly important that we work to create a society which is not only more tolerant and open, but also one in which people are able to access support which helps rather than harms them when they are struggling with issues like their sexual orientation.

Yesterday was supposedly “blue Monday” – the most depressing day of the year. The idea was dreamed up in 2005 by a TV marketing campaign to sell holidays and the myth persists.

But yesterday, Nick Clegg and I were talking about something really serious. Almost 4,700 people took their own lives in 2013 in England alone, and suicide remains one of the biggest killers for men under the age of 50. We hosted a conference bringing together leading figures in the mental health world to call for an ambition for ‘zero suicides’ across the NHS.

Charlotte Robinson was an incredibly bright, energetic, and well-liked young woman. She was working towards her A-levels, and hoping to attend Cambridge University. But days before her results arrived, Charlotte died. An eating disorder had left her dangerously weak, and she lost her fight with a sudden bout of pneumonia. When her A-level results arrived, she had achieved four As.

The inquest heard it had taken five weeks between Charlotte seeing her GP and an assessment being carried out by a mental health nurse, and it then took another month for any help to start. …

For too long mental health has been seen as a second-class issue in the NHS and I am determined to change that.

Today I’ve called for up to an extra £1.5 billion to be invested in the NHS next April. A significant amount of that money would go towards improving mental health services, especially for children and young people.

At our party conference in Glasgow, Nick Clegg said the Liberal Democrats will spend at least £1bn extra on health and care in each year of the next parliament, including £500m each year for mental health.

Imagine for a minute you are a teenager, perhaps working hard for your A-level exams, struggling with relationships and all the social and academic pressures of school. And on top of this, you might be among the 1 in 10 of your peers suffering from depression, an eating disorder, or another mental health problem.

But if mental health services are the “Cinderella service” of our NHS, Child and Adolescent Mental Health Services (CAMHS) are the Cinderella Service of Cinderella Services. Effective support for a young person experiencing a mental health problem can have a transformative effect on the course of their entire life. But the current CAMHS system too often is woefully inadequate.

Earlier this year, I launched a CAMHS Task Force involving experts in the field, and also young people who have experience of mental health problems themselves. The Task Force will look at how we can modernise children’s mental health service, making the best use of the resources available, and reforming services to end the “cliff edge” which occurs when young people move from under-18 care to adult services. It will look at how we can improve access – including through the use of exciting new online services – and how we can reduce the stigma of mental health services.

Today Simon Stevens, the Chief Executive of NHS England published his 5-year Forward Look, setting out the challenges facing our health and care system in the coming years.

It makes sobering reading. Simon Stevens sets out the huge scale of the financial challenge facing us in the years ahead as we continue to adapt to an ageing population, and increasing numbers of people living longer with multiple chronic conditions. We also need more investment to ensure that people with mental health problems can get the same standard of care and support as with physical health.

Earlier this month, the Liberal Democrats set out their priorities for the NHS. We committed to investing at least £1bn extra in our health and care system in each year in the next parliament. £500m of that will go to mental health to ensure mental health patients get fair treatment, and can access the support they need. And by the end of the next parliament we will give each carer £250 a year to recognise the immense contribution they make to society.

No major British political party has ever had a leader more committed to the cause of tackling mental health discrimination than Nick Clegg.

Nick’s first ever question in Prime Minister’s Questions as party leader was about mental health services. And throughout my time as heath minister, I have always been able to rely on Nick’s unwavering support for my work: on promoting parity of esteem for mental health; on tackling unacceptable standards of crisis care and support for children and young people; and in general raising the profile of an area of health that for far too long has been …

As a society we are judged by the way that we care for the vulnerable, the elderly, and those suffering from illness. Britain can be proud that in 1948 we led the world in laying the foundations for a universal health service, available to all regardless of wealth.

And we continue to lead the world today. Earlier this year the Commonwealth Fund rated the UK NHS best in the world overall, as well as in a number of specific categories.

In this Government, Liberal Democrats have protected health spending, …

There are currently 800,000 people living with dementia in the UK. By 2021, that figure is expected to rise to over a million. The disease costs the economy £23 billion a year, and that figure is expected to treble by 2040.

But as anyone who has come into contact with dementia will know, no statistics can convey the loneliness, isolation, and acute emotional distress that all too often comes with it – not just for those with the condition, but for their carers and family too.

In my time as Mental Health minister, I have written here several times about the unacceptable disparity between mental health and physical health in our health system. For far too long, physical health has been prioritised over mental health.

Perhaps the most stark difference is in terms of what happens when you suffer a mental health crisis. If you break your arm or suffer a stroke, you know that you will be taken to A&E, where you will get access to the expertise you need.

It’s very different in mental health. You may end up in a police cell or you may get sent a long way away from home to get a bed in a mental health unit. This would never be tolerated in physical health so why should it be acceptable in mental health?

If you watched Panorama last week, you will have been as horrified as I was by some of the footage. The treatment portrayed was disgraceful and a very clear illustration of the need for the changes that we are currently introducing in the health and care sector. As Liberal Democrat Care Minister, I am determined that everyone should be able to get good quality care, and to be treated with dignity.

I am sure that many of you will remember the stories about the Winterbourne View scandal a couple of years ago. Vulnerable residents with autism and learning difficulties were subjected to shocking abuse from those who should have been protecting and caring for them. The review that was carried out into the scandal highlighted the widespread and inappropriate use of physical restraint, including dangerous face-down restraint, at the hospital.

As a Liberal Democrat I am committed to tackling poor quality care, and ensuring that everyone in …

Back in 2012, an independent study of NHS case notes from hospitals concluded that in about 2.3% of hospital deaths there was strong evidence that death could have been prevented. In practice, this equates to around 6,300 preventable deaths in hospitals every year.

This is a shocking statistic. As Liberal Democrats, we should never fall into the trap of talking down the NHS – our health and care services do fantastic work day after day savings lives and providing excellent care. But we must also be willing to confront …

In Government, as in opposition, Liberal Democrats have been staunch defenders of people’s right to privacy, campaigning against state intrusion into people’s private lives. Our 2010 manifesto included commitments to scrap Identity Cards, block Home Office plans to snoop into people’s email and internet records, and remove innocent people from police DNA databases. In Government, we have delivered: ID cards were stopped, the “snoopers’ charter” revived by Tories at the Home Office was killed off by Nick Clegg, and millions of people’s DNA records have been deleted from Police databases.

People have a fundamental right to expect personal information to be …

When someone is experiencing a mental health crisis, it essential that they feel able to access the help they need – and quickly. They will probably be in a state of extreme distress and confusion. Without help, people may be at risk of causing harm to themselves and those around them (cases of injury to others are actually very rare). They often end up in police cells – completely inappropriately. They may even commit suicide – and all too often, I hear tragic cases of suicide after someone has repeatedly been unable to access mental …

A year ago last week, Robert Francis QC published his report into the failings at Stafford Hospital, and set out his recommendations to ensure that those failings would not be repeated. As a Liberal Democrat, I am committed to delivering better care, and ensuring that everyone is treated with dignity and respect when they come into contact with our health and care system. Today I want to report back myself on what we have achieved so far.

There are dedicated staff across the NHS and the care sector, who work tirelessly day after day to provide the best possible care for …

Later this evening, MPs will be given a vote on proposals to ban smoking in cars carrying children. It will be a free vote, and within each party there will be MPs who vote each way. If the proposal is approved, from next year it could become a criminal offence to smoke when there is a child in the car.

There would be no new police resource allocated to enforcing the ban proactively. But this would send a clear message out that smoking in cars with children is unacceptable, and I support the measure wholeheartedly.

I have been really impressed by the moving personal contributions on Lib Dem Voice today setting people’s own experience of mental health. It reminded me powerfully why I am a Liberal Democrat. As Holly Matthies wrote, tackling mental health stigma is fundamentally about freedom – freedom from poverty, ignorance, and conformity.

Mental health isn’t something that happens to other people. 1 in 4 people will experience a mental health problem at some point during their life – and everyone will know someone close to them who is affected. And we …

Support for those with mental health problems has come a long way since 2010. Rectifying the profound injustice in the priority given to physical health over mental health has been one of my highest priorities as Health Minister – as I know that it was too for Paul Burstow. When at least one in four people will experience a mental health problem at some point in their life, making sure they get the support they need to live independent and fulfilled lives is essential in delivering a stronger economy and a fairer society.

But there remains a very long way to go. People who rely on our mental health services – patients and carers – continue to experience unacceptable waits for services, and huge inconsistencies in the quality of provision. Some parts of our health and care system don’t do nearly enough to enable those with mental health conditions to live within their community, properly supported.

It is a really disturbing fact that 1 in 4 members of the prison population has a severe mental illness. Addressing this is one of the big social reforms which has not yet happened.

Far too often these conditions are diagnosed for the first time in prison. In many cases, their mental illness will have been a significant factor contributing to their criminal behaviour. If these people had been properly diagnosed when they first came into contact with police, and they had been provided with appropriate support and therapy, their offending actions might have been averted.

In 1997 Tony Blair told the Labour Party conference “I don’t want brought up in a country where the only way pensioners can get long-term care is by selling their home.” And yet speaking to the Health Select Committee in 2010, in Labour’s final months in office, Andy Burnham said, “every member of the Cabinet believed social care to be an area that had not been properly reformed and was one of great unfairness”. In thirteen years of talk, and promises, Labour did nothing to fix our dysfunctional, and profoundly unfair, system of funding social care.

Recent Comments

Sean Hagan21st Jan - 8:43pm@Andrew Houseley - you make an interesting observation about the challenge posed by decentralisation to “mercantile buccaneering capitalism”. Perhaps this helps to explain the obvious...

Joseph Bourke21st Jan - 8:10pmDavid Raw, I seem to recall the Liberal Party under Jeremy Thorpe did rather well in the February 1974 General election, drawing quite a bit...

Peter Martin21st Jan - 7:45pm@ JoeB, It isn't explained. It's just more assertion. A point that strikes me is that may be that 80% is produced in the private...

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